Guideline adherence of physiotherapists in the treatment of patients with low back pain: A qualitative study

Abstract

Rationale Adherence rates to guidelines show room for improvement, and increase in adherence to guidelines may potentially lead to better outcomes and reduced costs of treatment. To improve adherence, it is essential to understand the considerations of physiotherapists regarding the assessment and management of low back pain (LBP). The purpose of this study is to gain insight in the considerations of Dutch physiotherapists on adherence to the national physiotherapy guideline in the treatment of patients with LBP. Methods This is a qualitative study, using an interpretive approach of semi‐structured interviews with 14 physiotherapists who regularly treat patients with LBP. Thematic analysis was conducted with open coding using an existing framework. This framework distinguishes five components to adherence based on patient factors, provider factors, guideline characteristics, institutional factors and the implementation process. Results Participating physiotherapists mentioned that the guideline should provide more information about psychosocial prognostic factors and psychosocial treatment options. The participants experienced difficulties in addressing patient expectations that conflict with guideline recommendations. The implementation process of the guideline was considered insufficient. Physiotherapists might rely too much on their experience, and knowledge of evidence‐based treatment might be improved. In general, the interviewed physiotherapists thought they were mainly non‐adherent to the guidelines. However, when comparing their considerations with the actual guideline recommendations they were mainly adherent. Conclusion To improve adherence, the guideline should provide more information about addressing psychosocial prognostic factors, and Dutch physiotherapists might be trained in communication skills to better address patient expectations. A more extensive implementation process is warranted for the next guideline to increase the physiotherapists' knowledge of evidence‐based treatment.

Barriers, facilitators and implementation strategies for guideline-adherence in physiotherapy: a scoping review protocol

“…18 However, studies with different methodological approaches show that there are many barriers that hinder the implementation of guidelines in physiotherapy. [9][10][11] For example, Lemmers et al classify them as patient factors, guideline characteristics, institutional factors, implementation process and provider factors. 11 While various systematic and scoping reviews highlighted barriers, facilitators and implementation strategies for guideline-adherent practice in other health professions, 2 16 to our knowledge, there are no reviews of this type in physiotherapy.…”

“…However, health services are not consistently based on clinical practice guidelines and the availability of a guideline does not guarantee improved quality of care 5. Although there are numerous guidelines for physiotherapy practice,6–8 studies from different countries show that physiotherapists often do not follow guideline recommendations 9–11. A frequently studied construct, therefore, is the ‘adherence’ to clinical practice guidelines of clinicians to better understand the uptake and implementation of guideline recommendations and their effect on patient outcomes and healthcare utilisation 12–14…”

“…Physiotherapists generally have a positive attitude towards guidelines 18. However, studies with different methodological approaches show that there are many barriers that hinder the implementation of guidelines in physiotherapy 9–11. For example, Lemmers et al classify them as patient factors, guideline characteristics, institutional factors, implementation process and provider factors 11…”

“…5 Although there are numerous guidelines for physiotherapy practice, [6][7][8] studies from different countries show that physiotherapists often do not follow guideline recommendations. [9][10][11] A frequently studied construct, therefore, is the 'adherence' to clinical practice guidelines of…”

Effectiveness of Interferential Current for the Treatment of Chronic Low Back Pain

“…The prevalence of it is estimated to be between 30% and 80% among the general population and has been found to increase with age. A higher prevalence of LBP has been associated with lower socioeconomic status and lower education levels [12]. Therefore, LBP is the leading cause of activity limitation and absenteeism from work and results in a huge medical burden and economic cost [13].…”